心力衰竭是一種長期的慢性疾病，會隨著時間推移而惡化^{[8]<\/sup>。心衰影響全球約6400萬人^{[9]<\/sup>，具有高發病率及死亡率^{[10]<\/sup>。慢性心衰是導致65歲以上患者住院的主要原因，帶來巨大的臨床負擔和經濟負擔^{[11]<\/sup>。心衰根據左心室射血分數（LVEF），即心臟每次收縮時從心臟泵出血液的百分比可分為：射血分數降低型心衰（LVEF≤40%）、射血分數輕度降低型心衰（LVEF在41%至49%之間）和射血分數保留型心衰（LVEF≥50%）^{[12]<\/sup>。所有心衰患者中有約一半為射血分數輕度降低或保留型心衰，但其可選擇的治療方式很少^{[13]<\/sup>。<\/p> \n}}}}}}

DELIVER（評估達格列凈改善射血分數保留心力衰竭患者生活的療效）是一項國際性的、隨機、雙盲、平行分組、安慰劑對照、事件驅動的III期試驗，旨在評估與安慰劑相比，達格列凈在治療左心室射血分數高于40%的心衰患者的療效，不論其是否合并2型糖尿病。DELIVER是迄今在射血分數大于40%的心衰患者中開展的最大的臨床試驗，共有6263名患者隨機入組^{[14]<\/sup>。DELIVER III期試驗的結果顯示在總體研究人群中，達格列凈在降低CV死亡或HF事件的主要復合終點發生率方面優于安慰劑，相對風險降低了18%（95% CI 8%，27%），并且復合終點的所有組分均對療效有所貢獻。<\/p> \n}

DAPA-HF（達格列凈預防心力衰竭的不良結局）是一項國際、多中心、平行分組、隨機、雙盲的III期臨床試驗，入選了4744例射血分數降低型心衰患者，不論其合并或不合并2型糖尿病。該試驗旨在評估與安慰劑相比，在標準治療基礎上加用達格列凈 10mg每日一次的療效。主要復合終點是首次出現心衰惡化事件（住院或同等事件，如心衰緊急就診）或心血管死亡。中位隨訪時間為18.2個月^{[15]<\/sup>。關鍵次要終點包括因心衰住院（包括再次入院）和心血管死亡的總數，堪薩斯城心肌病問卷（KCCQ）總癥狀評分在8個月間與基線相比的變化^{[15]<\/sup>。<\/p> \n}}

達格列凈是同類首個人類鈉-葡萄糖協同轉運蛋白2（SGLT2）選擇性抑制劑，每日口服一次。達格列凈適用于降低癥狀性慢性心衰成人患者心血管死亡、因心衰住院或心衰緊急就診風險^{[16]<\/sup>。達格列凈在中國獲批用于成人慢性腎臟病，在飲食和運動基礎上治療未得到充分控制的2型糖尿病。隨著科學研究不斷發現心臟，腎臟和胰腺之間的潛在關系，研究也顯示出達格列凈在延緩心腎疾病以及器官保護方面的療效^{[15],[17]-[18]<\/sup>。單個器官的受損可導致其他器官功能障礙，這也是全球范圍內包括2型糖尿病、心衰和慢性腎臟病在內的主要死亡原因^{[3],[9],[19]-[20]<\/sup>。<\/p> \n}}}

心血管、腎臟及代謝始終是阿斯利康從全球到中國深耕的重要治療領域和增長引擎。通過遵循科學以更清楚地了解心臟、腎臟和胰腺之間的潛在聯系，阿斯利康積極投身于創新藥物的研發，來有效保護器官、減緩疾病進展、降低風險和應對并發癥，以改變或停止心血管、腎臟及代謝疾病的自然進程，并可能使器官再生和功能恢復，從根本上改善全球數百萬患者的預后，以變革性的科學為患者帶來一個更健康的未來。<\/p> \n

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久久久亚洲欧洲日产国码二区
參考文獻：<\/b><\/span><\/p> <\/td> \n <\/tr> \n
^{[1]<\/sup>.      Jhund PS, et al. Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER. Nat Med<\/i>. 2022;28(9):1956-64.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[2]<\/sup>.      Solomon S, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med<\/i>. 2022; 387(12):1089-1098.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[3]<\/sup>.      Mayo Clinic [Internet]. Heart failure; [cited 2023 Aug 1]. Available from: https:\/\/www.mayoclinic.org\/diseases-conditions\/heart-failure\/symptoms-causes\/syc-20373142.<\/a>  <\/span><\/p> <\/td> \n <\/tr> \n}
^{[4]<\/sup>.      Guo Y, et al. Heart Failure in East Asia. Current Cardiology Reviews<\/i>. 2013;9:112-122.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[5]<\/sup>.      Tsao CW, et al. Heart Disease and Stroke Statistics—2023 Update. Circulation.<\/i> 2023;147:e93-e621. PMID: 36695182.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[6]<\/sup>.      Warraich HJ, et al. Physical function, frailty, cognition, depression, and quality of life in hospitalized adults ≥60 years with acute decompensated heart failure with preserved versus reduced ejection fraction. Circ Heart Fail<\/i>. 2018;11(11):e005254.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[7]<\/sup>.      Oberfrank F, et al. Economic Burden of Heart Failure in Chinese Population. Value In Health<\/i>. 2016;19:A347 – A766.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[8]<\/sup>.      Cleveland Clinic [Internet]. Heart failure; [cited 2023 Aug 1]. Available from: https:\/\/my.clevelandclinic.org\/health\/diseases\/17069-heart-failure-understanding-heart-failure.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[9]<\/sup>.      Vos T, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet.<\/i> 2017;390(10100):1211-1259.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[10]<\/sup>.    Mozaffarian D, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. <\/i>2016;133(4):e38-360.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[11]<\/sup>.    McDonagh T, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J.<\/i> 2021;00:1-128.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[12]<\/sup>.    Heidenreich PA, et al. 2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of American College of Cardiology. <\/i>2008;10(10):933-989.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[13]<\/sup>.    Kosiborod MN, et al. The effects of dapagliflozin on symptoms, function and quality of life in patients with heart failure and mildly reduced or preserved ejection fraction: results from the DELIVER Trial. Presented at: American Heart Association (AHA) Scientific Sessions<\/i> 2022, 5-7 November 2022, Chicago, Illinois, USA.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[14]<\/sup>.    Solomon SD, et al. Dapagliflozin in heart failure with preserved and mildly reduced ejection fraction: rationale and design of the DELIVER trial. Eur J Heart Fail.<\/i> 2021;23(7):1217-1225.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[15]<\/sup>.    McMurray JJV, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med.<\/i> 2019;381(21):1995-2008.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[16]<\/sup>.    Forxiga Prescribing Information.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[17]<\/sup>.    Heerspink HJL, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med<\/i>. 2020;383(15):1436-1446. <\/span><\/p> <\/td> \n <\/tr> \n}
^{[18]<\/sup>.    Wiviott SD, et al. for the DECLARE-TIMI 58 Investigators. Dapagliflozin and cardiovascular outcomes in type 2 diabetes [article and supplementary appendix]. N Engl J Med<\/i>. 2019;380(4):347-357.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[19]<\/sup>.    Centers for Disease Control and Prevention (CDC) [Internet]. A snapshot: Diabetes in the United States; [cited 2023 Aug 1]. Available from: https:\/\/www.cdc.gov\/diabetes\/library\/socialmedia\/infographics\/diabetes.html<\/a>.<\/span><\/p> <\/td> \n <\/tr> \n}
^{[20]<\/sup>.    National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [Internet]. Heart disease & kidney disease; [cited 2023 Aug 1]. Available from: https:\/\/www.niddk.nih.gov\/health-information\/kidney-disease\/heart-disease<\/a>.<\/span><\/p> <\/td> \n <\/tr> \n <\/tbody> \n <\/table> \n<\/div>"];
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